Online education about end-of-life care and the donation process after brain death and circulatory death. Can we influence perception and attitudes in critical care doctors? A prospective study

Medical students' knowledge and attitude toward brain death and the influence of medical education: a cross-sectional study

BACKGROUND

The medical students' knowledge and attitude toward brain death has not been investigated in China. The aims of this study were to assess the knowledge and attitude toward brain death among medical students in China and assess the influence of medical education on the knowledge and attitude.

METHODS

An online questionnaire consisting of 17 questions was developed and completed by undergraduates majoring in clinical medicine in China Medical University. The students' demographic data, knowledge and attitude toward brain death were collected and analyzed.

RESULTS

A total of 1075 medical students participated in the survey, and 1051 of them completed the valid questionnaire. The exploratory factor analysis grouped the 17 items into four dimensions, which explained 63.5% of the total variance. These dimensions were named as knowledge (5 items), attitude (5 items), concern (3 items) and education needs (4 items) respectively. The global Cronbach α of the questionnaire was 0.845 and the Cronbach α of the four dimensions ranged from 0.756 to 0.866. The mean dimension scores of knowledge, attitude, concern and education needs was 3.67 ± 0.89, 3.67 ± 0.87, 3.10 ± 1.03 and 4.12 ± 0.72 respectively. The clinical students had a better knowledge than the preclinical students (P < 0.001). The clinical students had a more favorable attitude in stopping the treatment for a brain-dead family member and using the organs and/or tissues of brain-dead patients for transplantation (P < 0.001). The clinical students showed more concerns than the preclinical students (P < 0.001). There was no significant difference in the education needs between the clinical and pre-clinical students.

CONCLUSIONS

Most medical students in China had insufficient knowledge about brain death. Although their knowledge of brain death increased with their university degree, their attitude toward organ donation after brain death did not evolve accordingly. Their concerns about brain death increased with seniority. Most students had great education needs about brain death.

Evaluation of Physician's Attitudes and Knowledge Regarding the Diagnosis of Brain Death in Deceased Organ Transplantation in Northern Cyprus

Introduction Increasing deceased organ transplantation rates is an important strategy to overcome the organ shortage. Prior to the pandemic in Northern Cyprus, there were more transplants from deceased donors than from living donors. However, after the pandemic, living donor organ transplants were almost equal to cadaveric organ transplants. The purpose of this study was to explore the knowledge, attitudes, and experiences of hospital-based clinicians involved in the diagnosis of brain death and donor care in order to raise the deceased organ transplantation rate. Methods The study population consisted of three departments: physicians' anesthesiology, neurology, and neurosurgeons, who signed off on the brain death report. The demographic information of the participants was recorded. A total of 31 questions in the questionnaire were about personal experiences, attitudes toward brain death, organ donation, and donor care, and the level of knowledge and expertise required for the identification and care of potential organ donors. The answers are "agree," "indecisive," and "disagree." Results A total of 29 physicians, seven (24.1%) neurologists, six (20.7%) neurosurgeons, and 16 (55.2%) anesthesiologists answered the questionnaire. Although all of the participants stated that brain death is a definite death, it was determined that they did not agree on how the process should proceed for non-donors after the diagnosis of brain death. Conclusion Physicians' attitudes towards deceased organ transplantation are positive. It is pointed out that society's insensitivity and indifference to the decrease in organ donation rates. Multidisciplinary work motivation may increase deceased organ transplant rates.

The Effect of Educational Initiatives on the Attitude and Knowledge of Health Care Professionals Regarding Organ Donation and Transplantation: An Integrative Literature Review

BACKGROUND

This integrative literature review synthesizes evidence on the effect of educational initiatives (EI) on the attitude and knowledge of health care professionals regarding organ donation and transplantation (ODT), and the EI effect considering the risks of the ODT process related to the professionals' attitudes and knowledge.

METHODS

This search included 8 databases, with search terms across 4 groups: ODT activities, health professionals, attitude/knowledge, and EI. We applied the PICO framework to select articles: Population - health care professionals; Intervention - any EI; Comparison - pre/post or intervention/control designs; and Outcomes - indicators of attitudes or knowledge toward ODT. After the appraisal of 2,221 citations, 21 studies were included in this review.

RESULTS

The EI varied to a great extent in terms of format (seminars, workshops, video lectures; online or in-person training), duration (from 15 minutes to 3 months), and the number of participants (from 12 to 1011). The effects reported were positive, increasing professionals' knowledge and attitude regarding the ODT process for all EI formats. Most articles (14; 67%) presented positive results with statistical significance for all indicators analyzed, and the remaining studies (7; 35%) reported statistical significance for some of the indicators analyzed. All EIs focused on donation or post-transplantation activities, lacking studies on the transplantation stage.

CONCLUSIONS

Results suggest that different types of EIs may positively affect the attitude and knowledge of health care professionals regarding the ODT process. This study provides an up-to-date overview of the main themes examined in this literature, highlighting critical knowledge gaps and methodological flaws.

Attitudes Toward and Knowledge of Brain Death and Deceased Organ Donation Among Anesthesiologists in the Northeastern Region of Poland

BACKGROUND

Because in Poland transplant of organs from deceased donors is the predominant form of transplant, anesthesiology and intensive care specialists play a key role in the process. Insight into the work organization in intensive care units, anesthesiologists' and intensivists' level of knowledge and expertise, as well as personal opinions regarding declaring brain death and critical care of potential donors may be helpful in increasing transplant rates.

AIM OF THE STUDY

The objective of this survey was to identify factors and challenges influencing donation rates in intensive care units of hospitals of various reference levels in region.

METHODS

An anonymous, 31-question survey was sent to anesthesiology and intensive care specialists working in hospitals in one of the regions of eastern Poland. The survey was completed by 133 physicians, and a quantitative analysis was conducted on the data collected from submitted answers.

RESULTS

The average age of responders was 46 years (±10.24 years). Anesthesiology and intensive care specialists made up 80.45% of respondents. A vast majority of respondents (97%) expressed positive attitude toward transplant and are willing to donate their organs after death (92.19%). Meanwhile, more than 50% of them admit their lack of sufficient knowledge when it comes to declaring brain death. More than 53% of surveyed physicians have never had the opportunity to participate in training in methodology in performing brain death provided by their hospital or know about such training taking place. A vast majority of respondents (94.76%) see the need for workshops in potential organ donor care and brain death determination and would like to attend them.

CONCLUSIONS

This study shows a positive outlook toward organ donation and transplant but at the same time reveals a lack of knowledge and expertise among doctors working in intensive care units. That is why implementing education tools for identification, declaration, and maintenance of brain-dead donors could be one of the keys to enhancing donation.